Academic medicine : journal of the Association of American Medical Colleges
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Racism and bias are American medicine's fatal flaw. They permeate clinical practice and biomedical research, and their influence on medical education is even more profound because it is through medical education that racism and bias are perpetuated across generations and throughout history. This insidious influence has persisted despite the stated values of the medical profession and well-intentioned efforts to lessen their impact. ⋯ They also reflect on personal and structural lessons learned during the course of designing and implementing this initiative. Eliminating racism and bias demands that medical educators embrace a change process that is lifelong, people-centered, incremental, and nonlinear. It requires the courage to constantly course correct while never losing sight of the ultimate goal: health care and medical education that are free of racism and bias.
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Successfully teaching about race and racism requires a careful balance of emotional safety and honest truth-telling. Creating such environments where all learners can thrive and grow together is a challenge, but a consistently doable one. This article describes 12 lessons learned within 4 main themes: ground rules; language and communication; concepts of social constructs, intersectionality, and bidirectional biases; and structural racism, solutions, and advocacy. ⋯ Proficiency in discussing race and addressing racism will become increasingly relevant as health care institutions strive to address the social needs of patients (e.g., food insecurity, housing instability) that contribute to poor health and are largely driven by structural inequities. Having interprofessional team-based care, with teams better able to understand and counteract their own biases, will be critical to addressing the social and structural determinants of health for marginalized patients. Recognizing that implicit biases about race impact both patients and health professions students from underrepresented racial/ethnic backgrounds is a critical step toward building robust curricula about race and health equity that will improve the learning environment for trainees and reduce health disparities.
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Bias can impact all aspects of human interactions and have major impacts on the education and evaluation of health care professionals. Health care and health professions education, being very dependent on interpersonal interactions and learning as well as on the assessment of interpersonal behaviors and skills, are particularly susceptible to the positive and negative effects of bias. Even trained and experienced evaluators can be affected by biases based on appearance, attractiveness, charm, accent, speech impediment, and other factors that should not play a role in the assessment of a skill. ⋯ In addition, many of the learners develop knowledge, skills, and attitudes that appear to assist them with navigating bias in other learning or practice environments. In this case study, the authors reflect on these elements and how they can be replicated in other settings. According to the authors, modifying the learning environment to enhance and sustain relationships is key in addressing toxic bias.
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The medical community has been complicit in legitimizing claims of racial difference throughout the history of the United States. Unfortunately, a rigorous examination of the role medicine plays in perpetuating inequity across racial lines is often missing in medical school curricula due to time constraints and other challenges inherent to medical education. ⋯ This paper proposes the following recommendations for guiding efforts to mitigate the adverse effects associated with the use of race in medical education: emphasize the need for incoming students to be familiar with how race can influence health outcomes; provide opportunities to hold open conversations about race in medicine among medical school faculty, students, and staff; craft and implement protocols that address and correct the inappropriate use of race in medical school classes and course materials; and encourage a large cultural shift within the field of medicine. Adoption of an interdisciplinary approach that taps into many fields, including ethics, history, sociology, evolutionary genetics, and public health is a necessary step for cultivating more thoughtful physicians who will be better prepared to care for patients of all racial and ethnic backgrounds.
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Implementation of workplace-based assessment programs has encountered significant challenges. Faculty and residents alike often have a negative view of these programs as "tick-box" or "jump through the hoops" exercises. A number of recommendations have been made to address these challenges. To understand the experience with a workplace-based assessment tool that follows many of these recommendations, the authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with the tool. ⋯ This study demonstrates that the negative experience of faculty and residents with workplace-based assessment tools shown in prior studies can be overcome, at least in part, when specific implementation strategies are pursued. The findings provide guidance for future research and implementation efforts.